[Blocking of the brachial plexus: which technique(s) should be chosen?]

Area of Science:

• Anesthesiology
• Surgical Procedures
• Regional Anesthesia

Context:

• Upper extremity surgeries necessitate effective anesthesia techniques.
• A single brachial plexus block approach is insufficient for all procedures.
• Patient outcomes and surgical success depend on appropriate anesthetic choices.

Purpose:

• To review and compare preferred brachial plexus block techniques for upper extremity surgery.
• To identify optimal approaches for anesthesia and catheter placement.
• To discuss the role of neurostimulation and needle technology in brachial plexus blocks.

Summary:

• Brachial plexus anesthesia requires at least two main approaches: interscalene (above clavicle) for shoulder surgery and midhumeral (below clavicle) for elbow, forearm, and hand surgery.
• The supraclavicular approach is suggested for catheter insertion due to efficacy and low displacement rates.
• Neurostimulation, particularly multiple stimulations, is crucial for nerve localization, with increasing use of insulated needles for accuracy, though needle bevel choice remains debated.

Impact:

• Provides guidance on selecting appropriate brachial plexus block techniques based on surgical site.
• Highlights the importance of neurostimulation and discusses advancements in needle technology for improved accuracy and safety.
• Aims to optimize anesthetic management for diverse upper extremity surgical interventions, potentially improving patient recovery and satisfaction.